Mentalog

Challenges of Mental Health Diagnosing

Today’s methods of understanding and diagnosing mental health conditions are limited. New systems may help address these weaknesses. 

Maya was recently diagnosed with major depressive disorder by her therapist. The following week, she visited her primary doctor’s office. While there, her doctor said her mood issues may actually be due to a hormonal disorder. Her psychiatrist later disagreed with both diagnoses, and suggested that her symptoms are likely caused by post-traumatic stress disorder.

So what’s really going on with Maya? Experiences like hers expose the weakness of the commonly used mental health diagnosis system.

Unfortunately, such confusion with mental health diagnosing happens all too often. Individuals are frequently assigned different disorders by different health professionals. Treatment for those conditions can also vary widely.

Limits of the DSM-5

Traditionally, health professionals base their diagnoses on a guide called the DSM-5 (the Diagnostic and Statistical Manual of Mental Disorders).

However, this widely used tool is far from perfect.

Typically, a psychiatric diagnosis is given following an interview with a professional. They sometimes use standardized screens, based on the DSM-5, to determine if certain symptoms are present. The professional looks for the disorder that best matches the patient’s reported symptoms.

While, ideally, medical or biological issues would be ruled out first, they often aren’t. What’s more, people don’t always fit neatly into the diagnostic boxes. They may have only a few symptoms of a disorder, or might have symptoms from multiple conditions. This is partially why diagnoses from different professionals can vary so widely.

Inconsistent Screening Tools

Another possible reason professionals come to different conclusions is due to inconsistent use of screening tools. Patients are often asked to fill out symptom questionnaires, but the forms used vary among health providers, and even among researchers.

The screens also vary in accuracy. One screen for a disorder may have 12 questions, while another may have 40. And, knowing which screen to use, and what to screen for, relies on the training and experience of a particular professional. Such training varies wildly.

Pros and Cons of Mental Health Diagnosing

Many people find a firm diagnosis comforting. They finally know what’s wrong, and hopefully how to fix it. And ideally, this is how it works. Unfortunately, it isn’t always so simple.

In some cases, certain diagnoses might cause stigma, and could follow a patient around for life. Others internalize a diagnosis, and use it as a way to define themselves. This self-perception may not change, even as symptoms evolve or improve.

For example, someone’s symptoms of depression or anxiety might improve, but they could continue to label themselves as having mental health problems for life. Even medical professionals do this, not always re-assessing diagnoses, or making recommendations based on records from years ago.

What’s Normal, Anyway?

Some critics of the current system also note that the medical field may be labeling normal experiences as abnormal conditions. For example, it’s normal to grieve after a loss. It’s also normal for people to be disturbed for a few weeks following a trauma.

However, the current health system encourages, and often requires, health professionals to assign diagnoses to such experiences.

There’s also no agreed-upon idea of what mental experiences are normal. This has implications for not only diagnoses, but therapies, medications, and alternative treatments. In some cases, unneeded treatments are even found to make issues worse.

Alternative Systems

So, if the traditional system of understanding mental functioning isn’t ideal, what should professionals use? There are some alternative frameworks proposed, each based on their own perspective, but so far none has sufficent levels of clinical utility.

RDoC: The National Institute of Mental Health has developed a framework called RDoC for researchers to use when studying mental illness. This stands for the Research Domain Criteria Initiative. This framework integrates a wide variety of factors that help define a mental disorder, such as genetics, brain circuitry, patient behavior and self-reports. The hope is that this neuroscience-based framework will improve understanding of the biological changes associated with mental illness and help in the development of new treatments.

HiTop: Another alternative system used to look at mental health is HiTop, or the Hierarchical Taxonomy of Psychopathology. This framework considers symptoms along a spectrum of severity, rather than taking an all or nothing category approach like with the DSM-5.

Other approaches are being considered as well. For example, rather than looking at groups of symptoms that make up a diagnosis, some researchers are focused on the individual symptoms themselves. Others are looking at genetic factors, and how they present across mental health disorders.

Problems or Positives?

Some in the mental health fields have recognized for years that a focus on problems does not reflect the full picture. A field called positive psychology focuses on strengths and positive traits of individuals, rather than on what’s wrong with them.

However, even this system has a narrow focus, primarily addressing the wellbeing needs of those who are mentally well, rather than addressing the full spectrum from mental illness through to postive wellbeing.

The Mental Health Quotient

The Mental Health Quotient, or MHQ, aims to address the weaknesses of the current diagnosing system. It measures symptoms across multiple disorders and offers a uniform screen with multiple applications.

The MHQ also takes a spectrum-based approach from healthy functioning and strengths through to broader areas of concern. It also takes into account a person’s life context and situation, and considers how symptoms influence (or don’t influence) daily life.

The MHQ is currently being used to collect mental health and wellbeing data as part of the Mental Health Million Project, in order to create an evolving global map of mental wellbeing,  and make recommendations accordingly.

You can learn more about the MHQ, or even use the tool for yourself. In addition to considering a variety of areas of life functioning, this screen offers interpretation and recommendations based on score outcomes.

While patients like Maya may be understandably confused about what’s going on with them, such challenges of diagnoses don’t have to be accepted forever. A look at the whole person, rather than a limited snapshot, can help individuals start on the road to a happier, healthier life.